If the results of the rotary chair examination indicate a deficit of the VOR, particularly decreased gain or a significant asymmetry, we may start the patient on a series of exercises known to enhance the function of the VOR. Like most exercises, the goal is to push the limit of your performance to gradually increase your limit. Below, you will find the handout that we usually give to people who have no other issues beyond a peripheral vestibular disorder. There are many other VOR exercises not listed here, but we try to keep it simple so the patient does not get frustrated and quit. These are done at home, but we also frequently refer to Physical Therapy if there are any complicating factors. The main advantage of offering home exercises is that people will do them. Too often, a recommendation to go to a Physical Therapist is not followed through. Here is the handout:
Vestibular-Ocular-Reflex (VOR) Exercises
The primary role of the inner ear and vestibular system is to allow you to keep your eyes stable and focused on objects as you move your head around. The goal of these exercises is to enhance the communication between your inner ears and your eyes. The brain uses the inner ear information to determine how much eye movement is needed to allow your eye to stay fixed on an object as you move around. If you move fast enough that the brain perceives difficulty staying fixed and focused, the brain may increase the signal from the inner ear to adjust. Over time you will be able to move faster and still maintain visual stability. Make sure you mix up the speed and direction of eye movement, because that will best simulate real-life situations. These exercises help you recover as quickly and as much as possible from most inner ear disorders. When you finish an exercise session, you should feel a little uneasy. That means you have pushed the system sufficiently to trigger progress. If you feel perfectly fine, you are probably moving too slow. If you feel very nauseous, you are probably moving too fast.
- Take an item to read, hold it in front of you, move your head back and forth, up and down, around in circles both directions, as fast as you can and still be able to read the words on the page. Do each direction for about one minute, mix up the direction.
- Hold two items about arms length apart, move head quickly from one to other, up/down, side to side, for about one minute. Stay only long enough to establish focus, then move your head quickly back to the other object.
You should spend about 5 minutes, 2 to 3 times a day, performing the above exercises.